271
engage with the complexity rather than attempt to reduce it to measurable outcomes,
as is recognised by the UK Medical Research Council’s guidance on evaluating
complex interventions (Craig et al. 2011). Such methods might include natural
experiments/quasi-experiments analysed using stepped wedge or interrupted
time- series analyses (Hu 2015), and should include a process evaluation to take into
account the varying contexts in which the intervention takes place (Moore et al.
2015).
The shift from a medical model has encouraged a rethink of care and care provision and has latterly become established within a ‘Social Prescribing’ movement.
As a non-medical approach, social prescribing interventions promote personcentred and asset-based approaches for people with diverse needs (Polley et al.
2017). Social prescribing can support communities and individuals by placing the
“individual or service user in the driving seat so it creates the opportunity for real
and lasting behaviour change because it involves learning and making choices”
(Jackson 2016: 14). Also referred to as community referral or asset-based, personcentred approaches, there is no agreed single term used to describe social prescribing. Significantly, its definition may be difficult to hone as it is part of a larger social
movement, initiated by the UK National Endowment for Science, Technology and
the Arts (NESTA), based on ‘people-powered health’ designed to help reduce health
inequalities, as highlighted in the influential UK Marmot Report (2010).
A social prescription enables a health professional to collaborate with a link
worker or community navigator who facilitates a person-centred conversation to
design the participant’s own solutions to well-being (Bertotti et al. 2018). This wellbeing conversation can prevent unnecessary GP attendance, reduce hospital emergency admissions, reduce social isolation, and help support individuals with a range
of conditions (Kimberlee et al. 2014; Chatterjee et al. 2017). Approaches to social
prescribing range from long-term condition management to volunteer opportunities
with a focus on well-being through supported activities (Dayson et al. 2015). Since
2013, four models of social prescribing have emerged: (i) signposting; (ii) linking
with specific projects; (iii) joint partnerships; and (iv) holistic referrals (Kimberlee
2013). This includes, but is not exclusive to, therapeutic horticulture- and arts-based
approaches. The ways in which these activities occur are diverse and reflect the
contemporary public health approach adopted mainly within third-sector organisations, community groups and charities, rather than commissioned health services.
Examples of nature-based social prescribing interventions range from arranged
walks in forests to conservation volunteering and more structured ‘green-care’
activities such as those observed within therapeutic gardens, all of which fit within
the frameworks summarised in Fig. 11.3. Since the more active one becomes with
nature, the more likely the exposure to biodiversity, health professionals should
work with appropriate bodies to maximise biodiversity enhancement of naturebased social prescriptions. The case study in Box 11.2 explicitly brings people into
contact with biodiversity for the benefit of the health of participants and the planet.
11 Biodiversity and Health in the Face of Climate Change: Implications for Public…
engage with the complexity rather than attempt to reduce it to measurable outcomes,
as is recognised by the UK Medical Research Council’s guidance on evaluating
complex interventions (Craig et al. 2011). Such methods might include natural
experiments/quasi-experiments analysed using stepped wedge or interrupted
time- series analyses (Hu 2015), and should include a process evaluation to take into
account the varying contexts in which the intervention takes place (Moore et al.
2015).
The shift from a medical model has encouraged a rethink of care and care provision and has latterly become established within a ‘Social Prescribing’ movement.
As a non-medical approach, social prescribing interventions promote personcentred and asset-based approaches for people with diverse needs (Polley et al.
2017). Social prescribing can support communities and individuals by placing the
“individual or service user in the driving seat so it creates the opportunity for real
and lasting behaviour change because it involves learning and making choices”
(Jackson 2016: 14). Also referred to as community referral or asset-based, personcentred approaches, there is no agreed single term used to describe social prescribing. Significantly, its definition may be difficult to hone as it is part of a larger social
movement, initiated by the UK National Endowment for Science, Technology and
the Arts (NESTA), based on ‘people-powered health’ designed to help reduce health
inequalities, as highlighted in the influential UK Marmot Report (2010).
A social prescription enables a health professional to collaborate with a link
worker or community navigator who facilitates a person-centred conversation to
design the participant’s own solutions to well-being (Bertotti et al. 2018). This wellbeing conversation can prevent unnecessary GP attendance, reduce hospital emergency admissions, reduce social isolation, and help support individuals with a range
of conditions (Kimberlee et al. 2014; Chatterjee et al. 2017). Approaches to social
prescribing range from long-term condition management to volunteer opportunities
with a focus on well-being through supported activities (Dayson et al. 2015). Since
2013, four models of social prescribing have emerged: (i) signposting; (ii) linking
with specific projects; (iii) joint partnerships; and (iv) holistic referrals (Kimberlee
2013). This includes, but is not exclusive to, therapeutic horticulture- and arts-based
approaches. The ways in which these activities occur are diverse and reflect the
contemporary public health approach adopted mainly within third-sector organisations, community groups and charities, rather than commissioned health services.
Examples of nature-based social prescribing interventions range from arranged
walks in forests to conservation volunteering and more structured ‘green-care’
activities such as those observed within therapeutic gardens, all of which fit within
the frameworks summarised in Fig. 11.3. Since the more active one becomes with
nature, the more likely the exposure to biodiversity, health professionals should
work with appropriate bodies to maximise biodiversity enhancement of naturebased social prescriptions. The case study in Box 11.2 explicitly brings people into
contact with biodiversity for the benefit of the health of participants and the planet.
11 Biodiversity and Health in the Face of Climate Change: Implications for Public…